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Observational Study
. 2021 Jun 22;23(6):e26771.
doi: 10.2196/26771.

Acceptability and Effectiveness of Artificial Intelligence Therapy for Anxiety and Depression (Youper): Longitudinal Observational Study

Ashish Mehta  1 , Andrea Nicole Niles  2 , Jose Hamilton Vargas  2 , Thiago Marafon  2 , Diego Dotta Couto  2 , James Jonathan Gross  1
Affiliations
Observational Study

Acceptability and Effectiveness of Artificial Intelligence Therapy for Anxiety and Depression (Youper): Longitudinal Observational Study

Ashish Mehta et al. J Med Internet Res. .

Abstract

Background: Youper is a widely used, commercially available mobile app that uses artificial intelligence therapy for the treatment of anxiety and depression.

Objective: Our study examined the acceptability and effectiveness of Youper. Further, we tested the cumulative regulation hypothesis, which posits that cumulative emotion regulation successes with repeated intervention engagement will predict longer-term anxiety and depression symptom reduction.

Methods: We examined data from paying Youper users (N=4517) who allowed their data to be used for research. To characterize the acceptability of Youper, we asked users to rate the app on a 5-star scale and measured retention statistics for users' first 4 weeks of subscription. To examine effectiveness, we examined longitudinal measures of anxiety and depression symptoms. To test the cumulative regulation hypothesis, we used the proportion of successful emotion regulation attempts to predict symptom reduction.

Results: Youper users rated the app highly (mean 4.36 stars, SD 0.84), and 42.66% (1927/4517) of users were retained by week 4. Symptoms decreased in the first 2 weeks of app use (anxiety: d=0.57; depression: d=0.46). Anxiety improvements were maintained in the subsequent 2 weeks, but depression symptoms increased slightly with a very small effect size (d=0.05). A higher proportion of successful emotion regulation attempts significantly predicted greater anxiety and depression symptom reduction.

Conclusions: Youper is a low-cost, completely self-guided treatment that is accessible to users who may not otherwise access mental health care. Our findings demonstrate the acceptability and effectiveness of Youper as a treatment for anxiety and depression symptoms and support continued study of Youper in a randomized clinical trial.

Keywords: acceptability; anxiety; depression; digital mental health treatment; effectiveness.

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Conflict of interest statement

Conflicts of Interest: Authors ANN, JHV, TM, and DDC are employees of Youper and shareholders in the company. AM and JJG have no conflicts of interest to declare.

Figures

Figure 1
Figure 1
Example interaction with Youper. Users start by reporting a discrete emotion (A) and the intensity (B) which they feel the emotion. They then report which factors contributed to the emotion (C) and describe the precipitating event (D). Next, they proceed through a randomly selected intervention (eg, E or F) from the list (see Table 2). Finally, they report their discrete emotional state again and the intensity which they feel that emotion (A and B).
Figure 2
Figure 2
Symptom reduction over time in the full sample. The gray shaded region indicates bootstrapped SEs. Model details are described in the Results for Aim 2.
Figure 3
Figure 3
Path analysis diagram with standardized coefficients. This diagram shows the autoregressive and lagged relationships between the proportion of a user’s ER attempts that were successful out of their total regulation attempts and subsequent anxiety symptoms (A) or depression symptoms (B). ER: emotion regulation. ***P<.001, **P<.01, *P<.05. Exact P values are noted in the text.
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